My Story
About a year ago I went to have my first dental checkup in nearly two years. My dentist didn't even bother
to X-ray my front teeth. He hung the back X-rays up for me to see, comparing them with my two year old
X-rays, and announced "if you don't have these teeth capped soon, you are going to lose them."
"And how much does that cost?" I asked. Two years before, Dr. S had tried to sell me a splint to ward off
the effects of my bruxism (teeth grinding). But I couldn't figure out how this $125 implement was supposed
to help and he didn't really explain it, so I passed on it.
"Seven hundred and fifteen dollars per tooth," he said with what I hope wasn't really the
I-told-you-so air I seem to remember in his voice. "At a minimum, we need to cap these five, which are
almost down to the nerve, immediately." To "cap" or "crown" a tooth, the dentist grinds the original dooth
down to a post or cone shape, and creates a sculptured replacement tooth which is cemented to this sculpted
receiving surface. I would later learn that $715 is actually a very reasonable rate in the US; I've spoken
to people who paid from $850 to $1,400 for the same procedure, and to only one whose rurally located dentist
charged "only" $650.
I had a once-slight underbite which was no longer slight. My top teeth were sliding down behind my lower
teeth instead of meeting them, and my back teeth were all worn down to varying degrees so that the tips of
my incisors nearly met the opposing gums. All in all I had seven front teeth that weren't disastrously worn
-- and they were badly misaligned, as well as discolored.
What Dr. S was proposing was nearly four thousand dollars worth of work which would be little more than a
stopgap measure, leaving me with the same messed up bite and at least 15 more teeth waiting to give me
trouble in the future. I really couldn't see spending that much money to end up with the same problem.
Getting them all pulled and having dentures made was looking like a very reasonable alternative.
It was obvious to me, even though Dr. S didn't seem interested in telling me, that what I really needed was
to have all of my teeth capped at the same time so that instead of simply duplicating my
messed-up condition, my bite could be elevated and corrected. I didn't know it at the time but this is a
somewhat standard procedure called "full mouth rehabilitation." If Dr. S considered me a candidate for such
a procedure, he probably figured I was too cheap to pony up for it -- which was at least partially true.
I mentally multiplied $715 by 28 and groaned. Either my teeth were about to become the most expensive thing
I ever owned, or I was going to lose them and likely have to start wearing dentures at the age of 39.
The Idea
Some of you may remember that one of the good things that happened to me during the rollercoaster
year of 2003 is that a nice person gave me a perfectly driveable 1982 Chevy van. The nice lady who gave us
the van did so because she had only recently become a nice lady instead of a nice guy after her sex change
operation. And the van, as she said, "just wasn't me any more." In the process of collecting this gift we
heard her story, which included how she had travelled to Thailand to have both her sex reassignment and
gender enhancement surgery performed, because it was so much cheaper and there was no waiting list there.
A few days after getting the news from my dentist I put the words "Dentistry" and "Thailand" into Google and
my jaw hit the floor. The ceramic-over-metal caps my dentist wanted $715 for could be had for $125 at
several places that would even make my appointment and plot my course of treatment over the Internet.
It was still an iffy proposition, though, what with that $3,000 round-trip airfare to consider.
Thinking of other places, I remembered that Costa Rica has one of the best medical systems anywhere and is
also much cheaper than the USA. Googling "Dentistry" and "Costa Rica" revealed that I could have the
services of a world-class expert who had a lot more experience than Dr. S, at $350 per tooth.
I have to admit it was the girlfriend elsewhere known as "Y" who thought of Mexico. Once again we found
tales of $120 caps, and of an entire industry catering to American medical tourists. In several places
along the US-Mexico border, clusters of dentists operate within convenient driving distance so that an
inexpensive bus tour from Las Vegas or a trolley ride from San Diego could bring you to where this cheap
care was available.
Nowhere did we find a horror story -- indeed, everything we read was very enthusiastic. We did research and
began to lay plans.
Who Should Consider This?
First of all, if you live any distance from the Mexico border you should need a fair amount of work -- at
least two or three caps, or bridgework or some similar work that would run a few thousand dollars at home.
Depending on what you need done it is likely to take three or more trips to complete your course of
treatment, and it's silly to let travel expenses eat your savings.
Second, you may want to be wary of any procedure that involves major anesthesia, such as removing impacted
wisdom teeth. The drug laws make it practically impossible for a Mexican dentist to prescribe the most
potent pain therapies for you; an American pharmacist can't fill the prescription, and you can't bring
scheduled drugs back across the border if you fill it in Mexico. On the other hand there is also a lively
cosmetic surgery business operating in the same way, doing liposuction and facelifts and similar procedures,
so there may be a way to deal with this. It might involve staying in Mexico for a few days to recover; more
on that below. My procedure was extensive but involved no drugs other than novacaine and antibiotic
mouthwash.
Third, the work you need should not be just-invented cutting-edge stuff. Most Mexican dentists will have
access to state of the art adhesives, crown and facing materials, whitening agents, and so on; but only the
top tier will have lasers, computer models, and other recently introduced high-tech tools. While my
procedure was extensive it was done entirely with equipment that hasn't changed much since 1950.
Finally, you should be able to take the time off of work for the travel and "slop" days you'll want to
schedule in case something needs retouching. Like the travel itself, the lost work can quickly eat up your
savings on a modest job that requires multiple trips.
How do you Find a Dentist?
I did not do this, but most of the people who have had dental work done in Mexico tell you to go to Tijuana
or wherever it is convenient and look for a dentist. If you live in the Southwest you can probably find a
tour service that will make travel arrangements for such a "dental vacation." And if you just have one
tooth that needs a cap or similar minor work and you live within easy travel distance of a Mexican dental
destination, it might even make sense.
I have never felt comfortable taking such an informal approach with something so expensive and important,
though. I had to travel over a thousand miles and take significant time off of work, so I wanted to know
what I was getting into before getting on an airplane. So I waited to find a dentist who had e-mail. This
is still an unusual thing among Mexican dentists but I expect it to catch on fast. This way you can e-mail
photos and X-rays, and make travel accommodations sensibly. I found Dr. T in Tijuana, which is not very
close to New Orleans but makes for very convenient air transportation from just about anywhere in the US.
If anyone reading this needs work like mine done, e-mail me in private and I'll refer you to Dr. T. But if
you Google for tijuana-dental you will probably find him anyway.
Once I sent him my X-rays and photos of my teeth, Dr. T confirmed my own self-diagnosis and told me about
"total oral rehabilitation." He gave me several references who had had very similar work done, and indeed
on my first visit he showed me a study model of another patient whose condition was nearly identical to my
own.
How Long Does This Take, and How Much Does it Cost?
I had to send Dr. T my physical X-rays, since scanning them doesn't do justice to the details. Like all the
dentists I contacted about this he warned me that I would probably need an unknown number of root canals in
addition to 28 caps. (Depending on one's condition, bridgework and facing may also be part of the mix.)
Generally, it takes five days or so to make a cap, so you need two visits -- one to prepare your mouth, and
one to install the cap. The days in between can be vacation time in your strange destination or you can go
back home, whichever makes more sense.
In my case the extensiveness of the problem meant that before Dr. T could make caps, he had to make a study
model of my mouth and plan a course of action. He did not use any computer models to do this -- it was all
done with impressions, casts, and plaster models. He also had to verify, as I suspected from my local
dentist, that I didn't need any root canals after all. Root canals greatly stretch out your treatment
because it's unwise to do more than one or two at a time. They also add cost, because the root canal
(extracting the diseased nerve tissue and replacing it with inert material) must be followed by inserting
posts into the tooth to receive the cap. So you still have the cap, plus the posts, plus the root canal.
This is why some people who have this kind of work done in the US end up spending $40,000 on their teeth.
The study model delay meant that my eight-day stay wasn't long enough to have caps made and installed, so my
first visit to SoCal was almost a pure vacation -- or it would have been, if half of San Diego County hadn't
burned while I was there. My advice is to plan the first trip as a short one for your dentist to inspect
your condition and create a plan of attack.
Trip #2 was originally going to be to completely prepare and finish about half of my teeth, so I booked
another week in San Diego. After further study, though, Dr. T decided to do everything at once; trip #2
would be all preparation, and I'd have to wear temporary (plastic) caps while my real caps were being made.
In this way my bite could be corrected all at once. Alas, the airline reservations were already made so
once again I spent a couple of extra days out of town.
Trip #3 was to be a short one to install the caps and perform adjustments, but by now I was used to spending
a week in San Diego so I did it again. This gave me a chance to try out my new teeth at some of the great
restaurants I'd discovered on trip #1.
Meanwhile, the basic cost for work which would have run at least $20,000 in the US was around $8,000.
Even with all the travel and lost work I have saved between $10,000 and $20,000 by doing it this way.
How Do You Get There?
If you live in the US Southwest you have several options, but the simplest thing if you live any distance
away seems to be to fly to San Diego and get the work done in Tijuana. That's what I did, so that's what
I'll describe. (If you have a similar experience with another destination, please do comment on it.)
The key to using San Diego as a gateway is the Blue Line Trolley, a high-performance public transit system
that goes all the way from north San Diego to the border. Having travelled the entire Blue Line scouting
for hotels I can save you a lot of work and grief by telling you to stay on E street in Chula Vista:
- You can find a hotel in the $40 to $80 a night range. A Best Western, Days Inn, and Motel 6 are located
within rock-throwing distance of the E Street trolley terminal. Elsewhere the hotels are either very
expensive ($120 a night and up in San Diego) or a real hike from the trolley.
- Cab fare to and from the airport is a reasonable $25 or so. If you're adventurous you can also take the
992 bus from the airport to the America Plaza trolley stop, but it's a pain to do that with luggage.
- At the E street trolley stop there is a tourist information center that can tell you how to get anywhere
with public transit, sell you discount tickets to things like the zoo and Seaworld, and so forth.
- The E street hotels are a manageable walk or short bus ride from a public library which offers free
unfiltered Internet access. While there is a library just off one of the northern trolley stops, the
Internet access is limited.
There are vending machines at the trolley terminal. You can get a one-way or round-trip pass for a few
dollars based on your starting and ending destinations, or a "day tripper" that gives you unlimited riding
on all the trolleys and buses for $5.00. You can also get discounted Day Trippers for two three, and four
days, with four days coming in at $15.00. (You can also pay the San Diego Stupid People Tax by buying a one
day round trip ticket from San Ysidro to the opposite end of the line at Mission San Diego, which they will
cheerfully sell you for $6.00 -- a buck more than the unlimited use day pass. Go figure.) You can get a
lot more transit information online
The trolley has no access controls. Just buy your ticket, stand on the appropriate platform for the
direction you want to go, and when the trolley shows up press the button to open the door and climb aboard.
They do random spot checks for tickets, and you can expect to pay a hefty fine if you game the system by
riding ticketless. I've experienced four of these spot checks in the time I've spent riding.
Once you reach the border, follow the stream of humanity into the spiral ramp building to the pedestrian
bridge over the border. On the ground on the other side you'll pass through two turnstiles, and find
yourself at a cab stand.
Do not try to walk from the border into Tijuana. Trust me on this. My dentist e-mailed me a map and said
to show it to the taxi driver, but he did not count on the fact that a lot of taxi drivers in Tijuana can't
read. You need the local map yourself, but find a landmark on it. In my case the Plaza Rio shopping center
was the thing every taxi driver knew, with a convenient taxi stand to catch one going back to the border,
and about two blocks from my dentist. When you go through the turnstile you will be beckoned by eager taxi
hawkers. Ask one of them "How much to Plaza Rio?" (or wherever your dentist is near.) Always get the
price first in Tijuana. Border to Plaza Rio should be five dollars, and it's well worth it even though
it's a short ride. The area around the border in Tijuana is unbelievably snarled and confusing.
On your return, tell the cabbie "to the border" and you will be dropped off at an entirely different place.
Again follow the sidewalk and the drift of people to the customs station. You will have to go through a
metal detector and show your ID to an immigration official. You do not need a passport, but I have one so
that's what I used. At some peak periods there are long lines; if you make the mistake of taking your car
there are always long lines of traffic.
While you are in the Plaza Rio area, you can shop for your one permitted bottle of cheap liquor at the
Comercial Mexicana (think "Mexican Super Wal-Mart") in the Plaza Rio Mall, which is about 30% cheaper than
the tourist traps in walking distance of the border. Every business in Tijuana seems to take US currency,
and most are used to dealing with gringos like me whose entire Spanish vocabulary consists of "por favor,"
"gracias," "si," and "non." If you buy rum or tequila make sure it isn't made in Cuba -- Mexico trades with
them, but the US customs people will take it from you at the border.
What Other Ways Are There?
If you have or rent a car, do not take it into Mexico. This is a Very Bad Idea for a lot of reasons. You
can park at several places along the route between San Diego and Tijuana which offer bus service into
Tijuana, but most of these will drop you off at a place where you will be mobbed by vendors trying to sell
you stuff, and probably not very convenient to your dentist. Frankly I think you'd be better off parking at
the Beyer Street trolley stop in San Ysidro and buying a round trip ticket.
There is also a bus which has stops much more convenient to the hotels along I-5 in San Ysidro, but most of
the buses only offer half-hour service while the trolley offers 15 minute service most of the day. The
closer you stay to the border the more expensive it is to get to your hotel from the airport, too.
The border is not a pleasant place; it's the economic version of an "edge ecology." Edges where different
environments meet make for interesting animal and plant species, because you get all kinds of specialized
predators and prey adaptations. If you are going to Tijuana to spend thousands of dollars on your teeth,
there is a wide array of predators ranging from the over-aggressive merchant to the pickpocket who will want
your money. My advice is to limit their access to you. For the same reason I advise even more strongly
against staying in Tijuana itself unless you are very comfortable with the language and culture.
Even Chula Vista may be a little close for some peoples' comfort; it's a stereotypical Southern California
city that has grown too fast, planted in the desert where there is no particular reason for humans to live,
overpopulated with disaffected youth and poor people who struggle to pay the outrageous rents. There is a
lot of evidence of gang activity. The inexpensive hotels on E street get a bit rowdy on the weekend. It
was within my comfort zone but then I once lived in a similarly blighted neighborhood in New Orleans. The
main thing is to use common sense and avoid looking too affluent.
How Will the Work Go?
Here is where one caveat is in order. If you expect a medical facility to be in a nice glass and concrete
building with Muzak drifting from hidden speakers and a statuesque receptionist, you're going to be in for a
bit of a shock. Dr. T's office was small, in a building that needed some obvious repairs that were never
going to happen. The trimwork was uneven. And the receptionist doubled as his dental assistant, so she
sometimes had to leave my ongoing procedure to answer the phone.
This is all, however, in keeping with the Third World philosophy of putting the money where it's needed.
The equipment was all in good working order, everything was clean, and most of all I was very impressed with
both the doctor's bedside manner and his skill. After examining me on my first visit he explained exactly
what he was going to do, and added up how much it would cost before breaking out the novacaine.
Another item is interesting. He said that, normally, as part of an oral rehabilitation procedure that my
wisdom teeth would be extracted as a hygienic measure, because they can't be capped. (Think of where they
are, and the size of the tools.) I balked at this, because my wisdom teeth are one of the things my body
has managed to get right. They all came in perfectly and have never presented a problem, except for their
participation in the bruxism disaster. Where I'm sure an American dentist would have said "no, they need to
come out," Dr. T asked a couple more questions and finally said there wasn't really any need to pull them
now; if they ever become a problem I can always have them pulled. And furthermore, once the pressure is off
of them because the other teeth are crowned, they'll tend to rise, making them easier to extract in the
future. That settled it, and at the moment I still have my wisdom teeth.
It was clear to me that Dr. T was very experienced. He performed all aspects of my rather complicated
procedure with a manner of unhurried confidence. A procedure like mine is as much an art as it is a medical
procedure; working with hand tools the dentist must sculpt the living teeth into appropriate shape to
receive caps, and then must create caps which are not copies of existing teeth but instead are an original
sculpture which must both look good and function mechanically for eating. It may be important to note that
Dr. T is not at the bottom of the Tijuana price scale; while there are dentists who will do a single cap for
$120 he is not one of them. His prices run $280 to $350, and no doubt reflect his experience.
On my first visit Dr. T cleaned my teeth and took impressions; it then took him awhile to make the study
model and plan my treatment. On my second visit to San Diego I made two trips to Dr. T's office, spending
about 4.5 hours each time as he prepared my teeth and took more impressions. On my final trip, as I walked
in he told me "yours was an especially difficult case." In addition to the grinding down my TMJ (jaw joint)
had worn so that my jaw was a tiny bit to the left of where it is supposed to be. Nevertheless he felt that
with a couple of caveats my new bite would be acceptable. After about 3 hours of work he announced that the
caps were in, and while we would still need to adjust my occlusion I could now see how they would look.
What I saw in the mirror made me gasp. My teeth weren't just acceptable; for all intents and purposes they
were perfect. Although I could see the "cheats" Dr. T had had to accept in order to make my teeth meet,
they are not apparent to anyone who isn't an expert. My teeth which had never been straight or properly
aligned even in my childhood now looked like the "after" image from a toothpaste commercial.
That night I ate a steak at the Stuart Anderson's in Chula Vista. (I had been planning to go downtown on
the trolley and eat at Ruth's Chris, but I was just too tired.) After three weeks of eating mush and liquid
food because the plastic temporaries didn't function very well, and sensing with every bite how my new teeth
met properly, I think that is the single most enjoyable steak I have ever eaten.
Paying For It
The logistics of payment are pretty much the same as they are in the US. Dr. T accepts all major credit
cards, and that's how I paid him. He also will arrange payment plans and accepts US dental insurance. It's
worth mentioning that even if you have dental insurance, it won't cover a procedure like this in full; you
will probably still save a lot of money by going to Mexico. It's worth checking with your provider.
Dr. T quoted me a price in dollars and accepted payment in dollars. This seems to be fairly standard in
Tijuana. At the Comercial Mexicana, the cash registers do automatic currency conversion and they keep
American change.
What Else Is There To Do?
On your recuperative and slop days in San Diego, there is plenty to do.
You can take the trolley from Chula Vista to the College Station stop, then walk up C street and catch the
#7 bus (or just walk north another half-mile) to Balboa
Park and the world-famous San Diego Zoo. You can easily spend a week on the attractions at Balboa Park.
The zoo alone can fill a couple of days, and you won't want to miss the aerospace museum with its SR-71
Blackbird mounted on a pylon out front or the automotive museum with its actual Tucker Torpedo. I also
highly recommend the Model Railroad Museum, which is much more impressive than you might guess even though
it's a work in progress. There is excellent (if expensive) food both at the zoo and in the park, or you can
bring your own and picnic.
You can also take the trolley to the Little Italy exit, walk to the waterfront, and explore antique ships at
the Maritime Museum. If you're into steampunk the 140 year old metal sailing ship Star of India will make you swoon. And
hopefully there'll be someone aboard the Berkeley who can run its triple-expansion steam engine for
you to admire. You can also board the Surprise, the boat featured in the film Master and
Commander which they recently acquired on loan.
Or you can take the trolley to Old Town, cross the tracks and catch the #9 bus to Seaworld and see Shamu.
(Frankly I was more impressed by the penguins than the orcas, but that's just me.) Be warned, the food at
Seaworld is just expensive, and you can't bring your own. You can get two small free beers from the
Budweiser pavilion, though.
If you want to catch a movie, take the trolley up to the Fashion Valley stop where there is a large mall
with a nice stadium-style cinema. (I made the mistake of seeing The Matrix Revolutions there.)
There is also other shopping at the stops north of Fashion Valley if you want to go exploring.
Or you can just walk across the Chula Vista I-5 overpass to the parking lot for the nature center, and catch
the free shuttle to the interpretive center. If you're into birdwatching you can spend a whole day or more
there at Gunpowder Point, looking up shorebirds in your field guide.
You can also schedule a tour of the wineries (with samples!) or a boat trip in San Diego Bay. The tourist
center in Chula Vista was amazingly helpful, right down to reminding me of the bus connections I'd need.
So how did it come out?
Since a picture is worth a thousand words, here are the ones Dr. T took of my teeth:
- Before (warning, image may cause
loss of appetite)
- After
I have noted with interest that a lot of online brag pages for dentists show off rehabilitations that didn't
come out as good as mine. I credit that partly with the fact that I got to Dr. T before there was serious
root damage -- it was another dentist's warning, not pain, that sent me on this quest. But a lot of it goes
to Dr. T's very high level of skill and expertise. In particular, he completely fixed my underbite. If I
didn't see it in the mirror, I wouldn't have believed it to be possible. Dr. T is the very opposite of a
"discount" dentist, even if his rates were unbelievably low compared to US dentists.
If you've read this far, one thing I can't stress enough is to go to the dentist once in awhile. The amount
of grief a thing like this can cause increases exponentially past a certain point; catching it as early as
possible is key. One dentist I talked to in Costa Rica had a patient similar to me who was flying down from
Alaska once a month for five months to complete his treatment. In my case it came on suddenly
late in life, due almost certainly to work related stress. According to Dr. T, my X-rays show that four
years ago my teeth were in pretty good shape. Between the ages of 35 and 39 everything went to hell, and
because I skipped going to the dentist for two years it went to hell more than it needed to before I
realized drastic action was necessary. The occasional checkup can make the difference between minor work, a
smile that can be saved with major effort such as I just did -- or dentures, and all the hassle that
entails.
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